Reading heredity in racist environments: epigenetic imaginaries in Bessie Head's The Cardinals

The field of epigenetics research shows us how we are constructed by what is without-materially, socially and environmentally-while also taking us beyond narrow genetic determinants of heredity. If misappropriated, epigenetics research risks pathologising particular social or ethnic groups as biologically damaged. However, epigenetics may also allow us to better conceptualise the biopsychosocially constitutive nature of racist environments. In this article, I argue that epigenetic understandings of embodiment allow us to follow Achille Mbembe's recommendation: that to account for postcolonial relations of power-their effectiveness and psychology-we need to go beyond the binary categories (like passivity vs resistance) so frequently deployed in the analysis of domination. To demonstrate this, I offer a literary example from apartheid South Africa. In Bessie Head's The Cardinals, embodiment is imagined as the hereditary effect of segregated environmental space. The Cardinals thus offers something like a literary imagining of the epigenetic (as a material change that is heritable), before contemporary advances in epigenetics research made the connection between environment and embodiment more sensible in molecular terms. Head radically calls into question the certainty of biological identity: characters are 'marked' deterministically by their environments but ultimately the mutability of such 'epigenetic' markers is revealed when the individual transcends apartheid's spatial and racial demarcations. Writing in the context of apartheid, Head's engagement with non-genetic understandings of identity is a motivated attempt to evade the stigmatising categories and 'genetic' assumptions of scientific racism, which constructed races as biologically distinct (modern genetic science shows us that there is no genetic basis for 'race'). Instead, Head positions environmental spaces, including the Indian Ocean (a conduit for South Asian arrivals and for new philosophies and the potential political affiliations that arrive with them) as points of genealogical origin and as constitutive of identity in non-deterministic ways.

Audit of prostate cancer: lessons learnt for current clinical practice, surrogates for quality of care and standardisation and quality assurance

Two-hundred and fifty-one prostate cancer patients first registered during 1994 were sampled from a Regional Cancer Registry. In the six months after diagnosis, 39% received drug treatment alone, while 37% had no active treatment. Eighty-one percent of cases were histologically proven. Seventy-six percent had a prostate specific antigen (PSA) test and in 3% the PSA test was the basis for diagnosis. Of histologically proven cases 29% had a Gleason grade. None were staged by clinicians. Key lessons were: The result was a snapshot of current clinical practice which suggested other possible surrogates for quality of care, such as basis of stage and timing of investigations; There is a need for standardisation and quality assurance of the content of pathology reports; Standard treatment protocols would aid recording and comparison of treatments.

Audit of prostate cancer: validity and feasibility of registry-based staging

The sample consisted of 251 prostate cancer patients who were newly registered during 1994 from a Regional Cancer Registry. It was possible for 96% of cases to be staged by Registry clerical staff, but none had been formally staged by clinicians. In 45% of cases tumour extent was based only on Digital Rectal Examination (DRE), and on 32% there was no assessment found. 81% had no investigation of nodal status and 16% of cases had echography other than trans-rectal ultrasound. To find metastases 18% had scintigraphy and 13% had a plain chest X Ray while 61% had no investigation. Cox regression gave age-adjusted hazard ratios relative to stage A (95% CI) of 2.94 (1.59 to 5.44) for Stage B, 6.43 (3.37 to 12.24) for Stage C, and 9.03 (5.12 to 15.95) for stage D. Key lessons were: Registry clerical staff can abstract stage-related information from a high proportion of case-notes even if stage is not explicitly recorded by clinicians; The validity of registry based staging information is supported by survival analysis; This activity has resource implications and would be more appropriately performed by a member of the clinical team.